Obstructed Labour

Last updated 25.08.13

Definition

-      Presenting part of fetus cannot progress into birth canal despite adequate contractions during labour

 

Features

-       

 

Associated S/S

-      Haematuria

-      Anuria

-      Labour dystocia

-      Early ROM

-      Caput & moulding

-      Frequent long & strong contractions

-      Cessation or tonic contractions

-      Widest diameter of head palpable on abdominal palpation

-      Bandls ring

 

Causes

-      CPD: large baby, macrosomia &/or small pelvis

-      Malpresentation: brow, shoulder, face, breech

-      Fetal abnormalities: hydrocephalus, locked twins

-      Genital tract pathology: tumour, stenosis, tight perineum

 

Inlet

 

Outlet

 

Risk Factors

-      Short height <150cm

-      Ricketts or osteomalacia

-      Previous LUSCS

-      Previous stillbirth

-      Female genital mutilation

 

Complications

-      Uterine rupture

-      Fistulae: vesicovaginal, vesicocercial, rectovaginal

-      Fetal death

-      Instrumental delivery

-      LUSCS

 

Ix

-      VE

-     Oedematous vulva or cervix

-     Caput & moudling

-     Face, brow or arm presentation

-      Abdominal palpation

-      Urine output

-      CTG

 

Mx

-      IV fluids

-      Consider Abx if prolonged ROM >18hrs

-      Empty bladder: IDC or in-out catheter

-      Delivery

-     +/- episiotomy

-     CPD: LUSCS

-     Fully dilated

-    Station 0+ consider instrumental delivery

-    Otherwise LUSCS

-     Dead fetus: consider craniotomy or LUSCS

-      Continuous CTG

-      Analgesia

 

 

References